- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,365.16 / $10,964.78
| Facility | | $1,202.26 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $2,187.76
| Professional | | $812.83 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,244.36 / $14,791.08
| Facility | | $2,818.38 | $7,244.36 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,290.87
| Professional | | $851.14 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,949.84 / $6,760.83
| Facility | | $1,096.48 | $1,949.84 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $2,951.21
| Professional | | $912.01 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $2,041.74
| Professional | | $776.25 | $1,096.48 | $2,041.74 |